Effectiveness of Care for Child Development Program on the Sensitivity and Responsiveness Skills of Mothers

Objectives The present study was done to analyze the impact of the "care for child development" program on the sensitivity and responsiveness skills among mothers of children at risk of developmental delay. Materials & Methods This study was a quasi-experimental research with a pretest-posttest design and experimental and control groups. The statistical population included all mothers with children at risk of developmental delay in Tabriz. Fifty mothers were selected through purposive sampling. Then, they were divided into two groups of 25 cases (one experimental group and one control group) using simple random sampling. The experimental group received training about the “care for child development“ program, while the control group received no training. The Social-Emotional Assessment/Evaluation Measure Family Profile (SEAM TM family profile) and Maternal Caregiving Quality Scale were the research measurement tools. The obtained data were evaluated by analysis of covariance (ANCOVA) and independent t-test using SPSS software version 20. Results There was a significant difference between the experimental and control groups in maternal caregiving quality and responsiveness, provision of appropriate activities, predictable programs, and provision of play environment and safe home (P <0.05). Conclusion: The results showed that the care for child development program has positive effects on sensitivity and responsiveness skills of mothers of children at risk of developmental delays and can be considered and applied as a practical plan in national health policies.


Introduction
The condition of child development under the age of 5 in Middle Eastern countries is worrying. In spite of a decline in the prevalence of developmental delay in most countries between 1990 and 2016, its frequency has increased significantly in some areas, such as North Africa and the Middle East (1). It is reported that the frequency of children prerequisites for the child's neurological, physical, and psychological development and have protective effects (9,10). Sensitivity and secure attachment between child and caregiver have positive effects on gray areas of the brain involved in social, cognitive, and emotional functioning (11). As the most positive effect on child development (8), they are also strong predictors of child development at the age of 5 (12). These positive effects are detectable both in short term and throughout the life of the child (13). Even responsive parenting has the potential to promote normal development for children at risk for developmental delay, such as premature children (14). In general, although the results of various studies have shown that shown that the ability of a caregiver to represent sensitive and responsive care is inherent and influenced by genetic and some environmental factors, such as external stressors (22). The existence of a premature infant may also influence this skill (23) and can be challenged by premature children.
Since neonatal symptoms are not easily understood (24) and children's intelligence problems have a negative impact on maternal sensitivity (25), an increase in quantitative and qualitative knowledge of child caregivers has been emphasized (26,27) because by educating and supporting child caregivers, it is possible to enhance the knowledge of parents regarding child-rearing, sensitivity, and responsiveness skills (28, 29). Dunst and Kassow (2004)

Materials & Methods
This research was an applied study planned in quasi-  The exclusion criterion was the parents' reluctance to participate in the study at any phase of the study. The independent variable in this study was the care for child development program, which was adopted by the researchers based on the response to the intervention approach. The experimental group was exposed to this variable, which was provided by their health and medical services and the control group received no conventional treatment. Also, during the intervention, none of the subjects were deprived of the existing standard interventions.
Both groups were evaluated at the beginning of the study and three months after the study. Four sessions of two hours that were held weekly with two models of coaching and self-directed learning were considered (  consistency of scores over a 20-day period (36).
In this study, the sensitivity and responsiveness dimensions of this scale were used.

Results
In this study, the level of education of 56 % of mothers and 56 % of fathers were bachelor or higher (Table 1).

Discussion
The We also found that the CCD program was effective in promoting the competency of caregivers in providing appropriate activities. knowledge, provides possible ways to move toward the primary goal of promoting child development.
The caregivers will engage in learning activities in various situations, such as group activities in the classroom and individually at home. They evaluate their performance through self-monitoring tools as well as program orientation from coaching to training over time that reinforces a sense of competence, independence, and self-worth in caregivers, which include targeting and motivation, goal orientation, and performance activities (41).

In Conclusion
Lack of control over some important variables, such as socioeconomic status and mental health status of caregivers, as well as data collection based on caregiver self-reporting, are limitations of this study. Due to the positive impact of the program on caregivers in the present research and other research from other countries and the simplicity of the program, and its non-dependence on special instruments, this program seems to be highly applicable and can easily be used at home, kindergartens, and health centers. It can also be used as an applicable program in the health system of countries.

Acknowledgment
The present study was based on a doctoral dissertation approved by Allameh Tabataba